Revision Rates After Single-Level Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: An Observational Study With 5-Year Minimum Follow-Up.

STUDY DESIGN: Retrospective Case-Control study. OBJECTIVES: This study aimed to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF). SUMMARY OF BACKGROUND DATA: Prospective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported. PATIENTS AND METHODS: A nationwide database was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up. Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, comorbidities, and overall Elixhauser comorbidity index (ECI). Objectives were to compare the rates and risk factors of all-cause 5-year revisions for those undergoing single level CDA versus ACDF. Multivariate logistic regression models computed odds ratios (OR) of revisions within 5 years. P values less than 0.001 were significant. RESULTS: A total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revisions within 5 years were 1.24% for CDA and 9.23% for ACDF (P<0.001). After adjustment, patients undergoing single level ACDF had significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P<0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P<0.0001), depression (OR: 1.23; P<0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003). CONCLUSIONS: In this study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients regarding 5-year revisions following single level CDA or ACDF. LEVEL OF EVIDENCE: III.

AI-generated research paper fabrication and plagiarism in the scientific community.

Fabricating research within the scientific community has consequences for one's credibility and undermines honest authors. We demonstrate the feasibility of fabricating research using an AI-based language model chatbot. Human detection versus AI detection will be compared to determine accuracy in identifying fabricated works. The risks of utilizing AI-generated research works will be underscored and reasons for falsifying research will be highlighted.

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1- to 2-Level Lumbar Fusion.

STUDY DESIGN: Retrospective Case-Control Study. OBJECTIVES: The objectives were to determine whether patients from poor social determinants of health, undergoing primary 1- to 2-level lumbar fusion, demonstrate differences in (1) medical complications, (2) emergency department (ED) utilizations, (3) readmission rates, and (4) costs of care. SUMMARY OF BACKGROUND DATA: Measures of socioeconomic disadvantage may enable improved targeting and prevention of potentially increased health care utilization. The Area Deprivation Index (ADI) is a validated index of 17 census-based markers of material deprivation and poverty. MATERIALS AND METHODS: A retrospective query of the 2010-2020 PearlDiver database was performed for primary 1- to 2-level lumbar fusions for degenerative lumbar pathology. High ADI (scale: 0-100) is associated with a greater disadvantage. Patients with high ADI (90%+) were 1:1 propensity score matched to controls (ADI: 0-89%) by age, sex, and Elixhauser Comorbidity Index. This yielded 34,442 patients, evenly matched between cohorts. Primary outcomes were to compare 90-day complications, ED utilizations, readmissions, and costs of care. Multivariable logistic regression models computed the odds ratios (OR) of ADI on complications, ED utilizations, and readmissions. P -values <0.05 were significant. RESULTS: Patients with a high ADI incurred higher rates and odds of developing respiratory failures (1.17% vs. 0.87%; OR: 1.35, P =0.005). Acute kidney injuries (2.61% vs. 2.29%; OR: 1.14, P =0.056), deep venous thromboses (0.19% vs. 0.17%; OR: 1.14, P =0.611), cerebrovascular accidents (1.29% vs. 1.31%; OR: 0.99, P =0.886), and total medical complications (23.35% vs. 22.93%; OR: 1.02, P =0.441) were similar between groups. High ADI patients experienced higher rates and odds of ED visits within 90 days (9.67% vs. 8.91%; OR: 1.10, P =0.014) and overall 90-day expenditures ($54,459 vs. $47,044; P <0.001). CONCLUSIONS: Socioeconomically disadvantaged patients have increased rates and odds of respiratory failure within 90 days. ED utilization within 90 days of surgery was higher in socioeconomically disadvantaged patients. Social determinants of health could be used to inform health care policy and improve postdischarge care. LEVEL OF EVIDENCE: Level III.

Preoperative Depression Screening in Primary Lumbar Fusion: An Evaluation of Its Modifiability on Outcomes in Patients with Diagnosed Depressive Disorder.

OBJECTIVE: Studies have reported the detrimental effects of depression following spine surgery; however, none have evaluated whether preoperative depression screening in patients with a history of depression is protective from adverse outcomes and lowers health care costs. We studied whether depression screenings/psychotherapy visits within 3 months before 1- to 2-level lumbar fusion were associated with lower medical complications, emergency department utilization, readmissions, and health care costs. METHODS: The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1- to 2-level lumbar fusion. Two cohorts were 1:5 ratio matched and included DD patients with (n = 2,622) and DD patients without (n = 13,058) a preoperative depression screen/psychotherapy visit within 3 months of lumbar fusion. A 90-day surveillance period was used to compare outcomes. Logistic regression models computed odds ratio (OR) of complications and readmissions. P value < 0.003 was significant. RESULTS: DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR 2.71, P < 0.0001). Rates of emergency department utilization were increased in patients without screening versus screening (15.78% vs. 4.23%; OR 4.25, P < 0.0001), despite no difference in readmissions (9.31% vs. 9.53%; OR 0.97, P = 0.721). Finally, 90-day reimbursements ($51,160 vs. $54,731) were significantly lower in the screened cohort (all P < 0.0001). CONCLUSIONS: Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, emergency department utilization, and health care costs. Spine surgeons may use these data to counsel their patients with depression before surgical intervention.